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Using the Malcolm Baldrige Criteriato Create High Performance

Presentation to IHI, Session M23

December 10, 2012

Susan S. HawkinsSenior Vice President, Performance Excellence

Henry Ford Health SystemThiis presenter has nothing to disclose

Henry Ford Health System (HFHS)

Core Services:� Four acute med/surg and two

behavioral health hospitals� Henry Ford Medical Group

– 32 Medical Centers– 1200 physicians & scientists

� 2200 private physicians� 1500 MD & DO physician

trainees� Health Alliance Plan

Post-acute services:� 2 Skilled nursing facilities� Home Health Care� Outpatient Dialysis� Home Products� Retail Pharmacies� Vision Centers

Other Statistics (annual):� Over 23,000 employees� Over 200 care delivery sites� 102,000 admissions, 2200 beds� 418,000 ED visits� 3.2 million office visits� 88,000 surgeries

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2011 Baldrige Performance Excellence

Award Recipients

� Concordia Publishing House, St. Louis, MO– $35M revenues, 247 employees

� Henry Ford Health System– $4B revenues, 24,322 employees + 5534 affiliated physicians,

volunteers, and students

� Schneck Medical Center, Seymor, IN– $96M revenues, 800 employees + 650 affiliated physicians,

volunteers, students

� Southcentral Foundation, Anchorage, AK– $201M revenues, 1487 employees

First year that three health care organizations were selected at one time

Now Eight Years of Focused Learning

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“The Henry Ford Experience” 7 Pillars of Performance

HFHS Employee Engagement

Community Giving

People

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Service

Good

Quality & Safety

HFHS

NRC Best Overall Quality vs. Competitors

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GrowthHFHS Inpatient Market Share

Good

Community

Economic Driver

� $5.82 billion in direct/indirect economic benefits

� Live Midtown Project

� Neighborhood development

Community Leader

� Serve in leadership roles in key organizations, such as Detroit Chamber of Commerce, Detroit Convention & Visitors Bureau

� Leadership volunteer hours exceed 12,000 annually

� Community benefit � 78%, $400M

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Finance

Philanthropy Cash Donations

Key Changes Leveraging Baldrige

� Leadership Processes and Structures

� Strategic Planning

� Organizational Performance Measurement and Accountability for Results

� Customer Engagement

� Employee Engagement and Development

� Renewed Focus on Process and Improvement

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Mission, Vision, and Values

Mission

To improve people’s lives through excellence in the science and art of health care and healing

Values

Each Patient First Respect for People

High Performance A Social Conscience

Learning and Continuous Improvement

Former Vision Statement

To put patients first by providing each patient the quality of care and comfort we

want for our families and ourselves.

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HFHS Core Competencies

� Innovation – Discovering and applying new knowledge in

techniques, technology, processes, services, and structures

– Clinical Research & Technology

– Facilities

– Services and Access Points

– Processes

� Care Coordination – Proficiency in coordinating care

across the continuum, teams

� Partnering/Collaborating – Relationship- building with

stakeholders, community, interdisciplinary

Created Performance Council and New Leadership Processes

� Feedback showed opportunities to create more systematic leadership processes to drive strategic planning, deployment, and alignment

� Many performance targets – and results – remained the “responsibility” of a few vs. everyone

� Evaluated all current leadership teams: membership, roles and responsibilities, meeting frequency, and perceived effectiveness

� Created a “picture” of our Leadership System

� Launched the HFHS Performance Council

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HFHS Leadership System

Performance Council

� Comprised of leaders of every Business Unit, pillar team, and key Corporate area

� Charged with overseeing the Strategic Planning Process and Organizational Performance Review

� Provides clear direction and decision making process to those seeking approval of or input to projects, policies, and initiatives (clarifies role of all leadership teams)

HFHS Board of Trustees

Performance Council

Business Unit Leadership Teams

Executive Cabinet

Pillar Teams

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Other Changes to HFHS Leadership System

� Created an Enterprise Risk Council with System-level goals:– Develop and execute/oversee HFHS’s approach to Enterprise Risk

Management (ERM)

– Ensure ERM strategies are integrated into the overall strategic plan.

� Reinforced System-wide teams, accountable to Performance Council, to provide broad inputs and greater spread

– Continue to assess these teams at least annually for opportunities to improve effectiveness and efficiency

Improved Strategic Planning and Implementation

� Multiple refinements to the Strategic Planning Process

– New processes focused on the criteria

– New common vocabulary:

• Strategic Objectives

• Strategic Initiatives

• Action Plans

• Performance Targets

– Aligned the strategic planning and budgeting processes

– Clear expectations for aligned action planning

Conduct Scenario Planning &

Develop Strategic Objectives

Develop & Prioritize Strategic Initiatives

Develop Action Plans & Set Targets

COMMUNITY PURCHASERS

PATIENTSReview Organizational

Performance

Affirm MVV & Environmental Assessment

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Cascading Strategic Initiatives

Strategic Plan identifies:

� Alignment between Strategic Objectives, Key Performance Measures (and targets), and Strategic Initiatives

� Clear identification of owners

� Clear accountability for strategy cascade starts at PC

� All business units must create and share an action plan that shows alignment to System initiatives as well as “local” strategic initiatives, all organized by the 7 pillars

� Pillar teams or other System teams also create and share action plans

� Targets for next three years for each System performance measure (reported throughout year on System Dashboard)

Improved Measurement andAnalysis Capabilities

� Metrics Committee operational, financial, and pillar leaders who provide oversight and expertise to pillar teams and the Performance Council on the best way to define, display (dashboards), compare, and analyze transparent organizational performance

� HFHS Analytics department

– Measurement and Comparator Selection

– Business Intelligence Oversight

– Dashboards/Organizational Performance Review

– Knowledge Management

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Organizational Performance Review

� System-level dashboard and monthly review of measures at Performance Council (PC)

� Continuous search for best measures and comparators / databases

� Semi-annual review of all pillars and business units at PC

People

EngagementTurnover

Service

Cust. Engagement (Top Box)

“Likelihood to Recommend”

HCAHPS

Quality & Safety

No Harm: Acute HarmReadmissions

Growth

Admission VolumesTri-County IP Mkt share

HAP Membership

Finance

Net Operating IncomeCost Per Unit

System Dashboard

System Dashboard

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Available to all Employees

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Sample Business Unit: YTD Performance on Key Metrics

Transparency and Accountabilityat each Business Unit

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From Customer Satisfaction To Customer Engagement

� The 10 Team Member Standardsof Excellence

� Keep the “face of the customer” at the forefront everyday

� Huddles

� Mandatory Service Training� Effective communication � AIDET

Team Member Standards

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Leadership Competencies & Standards: Aligned to Baldrige

� 40% of Leader and Staff evaluations tied to leader/team standards

� Incentives aligned with organizational goals

Engaging Workforce Through Communications

� Structure: CEO led, all PR staff integrated, link to Pillars

� Process: Consistent, repetitive messaging Multimedia, multi-tacticEmployee champions: service, safety, equity

� Engage Face-to-Face: Town Halls, Leadership Rounds, Huddles, multiple recognitions

Huddles

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How Do We Design and Improve?HFHS Model for Improvement (MFI)

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Work Systems & Key ProcessesWork System & Key Process – Focus on “Each Patient First”

Model for Improvement

Used broadly in our leadership system . . . .

From designing new worksystems� HF West Bloomfield Hospital� Patient-Centered Medical Home

To kaizen events . . . To front-line daily improvement

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Infection

EmployeeOther

Medication Harm

Procedural

Care Delivery

C-Diff

Coded

Complications

Falls

Pressure Ulcers

Back Injury

Sharps

Assaults

Renal Failure

Blue Alert

OB Harm

Hypoglycemia

Sources of

Harm

Harm is unintended physical injury resulting from or contributed to by medical

care that requires additional monitoring, treatment or hospitalization, or that

results in death whether or not considered preventable.

Anticoagulation

Narcotics

Other

NSQIP

Pneumothorax

BSIs

VAPs

UTIs

Surgical Site Infections

Antibiotic Stewardship

Sepsis

Deep venous thrombosis

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Leveraging our Core Competencies“Put Everyone to Work”

Efficient Use of Resources

� Public Relations, Human Resources, Quality and Safety, Performance Improvement, and Finance partnership

� Safety Champion network

� Delegate accountability and build on existing operational systems

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Infrastructure to Share Learnings and Deploy Improvement

System Quality Forum

Care InnovationTeam

Other QualityInitiatives

No Harm Steering

Committee

Medication(Pharmacy Council)

Falls & Pressure Ulcers(CNO Council)

Culture Change(Quality Forum)

OB Harm (OB Collaborative)

Procedural Harm (NSQIP SystemCollaborative)

Glucose(CMO Council)

BSI, VAP, SSI,C-Diff, UTI

(Infection ControlCouncil)

SharePoint Site

Sharing metrics;

Building accountability

Design, Manage,

Improve

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HFHS Overall No Harm Results

30

35

40

45

50

55

60

1.5

1.6

1.7

1.8

1.9

2

2.1

2.2

2.3

2.4

2004 2005 2006 2007 2008 2009 2010 2011

HF

HS

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nts P

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,00

0 A

cute

Ca

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ay

sS

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Mo

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Ra

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HFHS Harm Events and Hospital Mortality Rate Trends

HFHS Mortality HFHS Harm AHRQ Nat'l Safety Index

Insulin

Protocol

SSI work

Sepsis

Protocol

IHI 100K

Lives UTI

WHO Surgical

Checklist

DVT

Hi-Risk Med

Management

Infection

Prevention

-40%

-31%

CMS mortality comparator :

-17% / 6 years

Improving our Culture

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Lessons Learned� Essential for senior leaders to drive, support and actively participate

in Baldrige improvements– CEO commitment and involvement

– Leaders as Champions, Category Co-leads

� The Baldrige Framework has to be integrated into everyday business – not a separate project – to build sustainable improvements

� The writing (and associated self-evaluation) generates as much learning as the feedback reports

� Spread the knowledge – build examiner competency across the organization (we started at the State level)

� It’s OK to use the “B” word – builds common understanding

� Winning does not mean perfection

� Clarify and communicate: award or strategy?

2012 and Beyond: The Journey Continues

� Key System-wide priorities based on examiner feedback and pre-/post-visit self-assessments:

– Refine our approaches for identifying and spreading improvements, innovations, and best practices; learn from others at Quest

– Continue to communicate and connect System goals and current performance, opportunities, and responsibilities to individuals and front line teams; refine strategic planning process steps to hard-wire “tight-loose-tight”

– Re-evaluate and re-align key processes, owners, and measures at all business units and work systems

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Questions?